Jacob Ham, PhD: "The Opposite of Trauma is Presence" (Ep 1 of the Fresh Start Podcast)

[Music] good morning dr jacob hamm uh good morning hi good morning nice to see you uh you're you're on the farm oh it's a um it's a place in upstate new york this corporate retreat center that the psychiatric department took us to one year i just took that picture i thought it was lovely and who doesn't want to be on farm these days when we're all stuck in our apartments so your story you're talking about training psychiatrists um or yeah could you talk a little bit about your background obviously first off for full disclosure our relationship is that we're both involved in a program called fresh start uh recovery center which is a uh i guess you'd how would you describe what what's it what's it called what type of a it's a week-long retreat for people to give them a real foundation in understanding the impact of trauma on their lives um to give them a real experience of what it could feel like to be free from it and to go back into their lives and keep looking for other ways to keep growing started by a friend of ours i can't pronounce his name the way he'd yet yeah he started it and and and just so everyone understands we're both on the advisory board there i'm i do sort of the rabbinical stuff and of course you you're there because well you were just talking about you know training psychiatrists and just talk a little bit about your uh background your expertise especially in trauma um sure um i've been shoot i i trained in the in the 90s so i've been doing clinical work for a long time even though i look like i'm like in my 20s or 30s or whatever um and let's see the the first exposure to trauma work was actually in grad school we had an incredible semester-long course on trauma and um i found it the most profound course that i'd taken i had just taken a we we did a year-long course just memorizing the dsm which is the diagnostic bible for for therapy we memorized every criteria for every disorder and then we had half a semester of um trauma work it was an elective but the dsm course was a requirement and like every other medical student although i wasn't in medical school it's called a medical student syndrome every disorder that we covered in the dsm i went to my therapist crying like i think i have this oh my god and he would just laugh the way you are and then whenever i got to trauma it was like oh i have this for real and we all do we we all can because trauma is the only disorder in the dsm that's actually rooted in something really bad happening to you everything else pretends like it's like purely biological and sure certain diseases like schizophrenia and bipolar ocd they have much more of a biological factor or variable driving it but there's a lot of stuff like urine typical neurotic disorders like anxiety depression that has a huge external component and we were minimizing that component and just playing up the biology part and that's what felt so pathologizing for me and then trauma was also the it was actually even though it was rooted in environment the science behind trauma was profound they had traced the impact of stress and trauma on the functions of the immune system the nervous system the biology the neurobiology the epigenetic impact epigenetics is this new science that looks at the impact of environmental factors on reprogramming gene expression that can last for generations on out and so that's incredible and then play in plain english what you're saying is that my trauma doesn't even have to be something happened to me it could have happened to my parents or grandparents definitely they've definitely documented that this has profound impacts yeah especially around the time of the baby's birth or during pregnancy and right after pregnancy stress around that time wires the child to be ready for a life full of stress low resources and dangerous predators are all around i i know that you do a lot of i mean you work with all types of patients from all types of of backgrounds but i know you have would you say you have a disproportionate amount of jewish clients i mean bigger than the than the population at large disproportionately larger oh yes for sure than the 2017 well being in new york okay that's that'll also uh yeah skew the the jewish numbers but yeah wait what do you what do you say about like the fact that is there any reality to the idea that that jewish people are carrying around stuff from this very long history and i mean we all joke about it but tell me how real do you think that is it's been documented there's a there's a professor at mount sinai where i work rachel yahooda who's done research studies to show that the grandchildren of holocaust survivors have changes in gene expression that impact their capacity to tolerate stress um so doctor i you know when you speak about trauma you mentioned before that it's it's it's it has its root in something that happened and you mentioned it doesn't necessarily mean it happened to you it could have happened a generation ago but um what do you think you know when you say when you speak about something happened so there are certain things that we think of as like oh that if that happened that would be traumatic we all agree that something like that if it happened that would traumatize a person what do you think is the biggest misunderstanding as far as a cause of trauma that people don't even it doesn't even occur to them oh oh that's traumatic that could that could traumatize somebody you're nodding your head what is it what do you have in mind um it's the uh pervasiveness of neglect and the and the range of neglect that people can experience that's the most ubiquitous and i think the research is also showing that it has maybe the greatest impact like physical abuse that's you can ground that you can you can say oh yeah i remember that my parents used to hurt me physically and that's their fault that's on them but no one remembers the neglect oh the only thing that's left in the adult is i'm a bad kid i'm really not that lovable i'm really not worth your time i don't really matter and my parents did the best they could it's weird it gets distorted and so a lot of time i'm trying to convince people that they were somehow like neglected or traumatized even though it's a small t trauma because it happens day to day over and over again and i try to help them understand what the impact of that can be on on their ability to be resilient in survival life's travails aha so you're saying when something happens the person can remember that this happened and it has had and they could understand they can appreciate how it could have had this cause this this effect on them but when nothing happened it's very hard to attribute any causality to it nothing happened exactly yeah i'm just making it up they weren't that bad they still provided food they sent me to school they bought me gifts so a parent who's sending a child to school giving them food giving them clothing giving them shelter then tell me what is neglect it's when you feel distressed every child that feels distressed seeks comfort and proximity to their caregivers and then it's how the caregiver responds in that moment that matters so much does the does the parent recognize that this is a bid for comfort or do they see it as like oh no children don't cry be tough which is survival parenting if you're living under duress then there's no room for crying crying can get you into trouble in fact in my own family there's a there's a family member who um cried when the chinese were coming down from north korea and because he didn't want to brush his teeth and when because he cried the soldiers found him and they abducted the brother that was trying to protect him they they lost him to that so it's it really is life or death you do not you do not have time to cry in battle wow wow and and and uh and you're telling me that that mentality that was life or death in that terrible situation it sounds like what you're implying is that they a person doesn't just turn off that mentality when they're in a place where they can't you say you can't just turn it off it's nearly impossible why would your body let you stop doing the thing that saved your life and it's ingrained in you at such a formative time in your life so how do you free people from it one you honor that that was necessary to survive that time and then you start to do this weird thing i call it um you activate presence i always say that the opposite of trauma is presence and what i mean by that is that um what trauma does is that it makes us compartmentalize ourselves like in the shamanic tradition they talk about how like whenever there's a trauma then you tuck away and hide parts of your soul for safe keeping so that it doesn't get injured by the trauma and so a lot of the work in shamanic healing is actually to go and retrieve those parts of yourself that you buried away and i feel like i'm doing that constantly with people i'm retrieving all the parts of themselves that weren't allowed to be integrated making them whole and the way you do that is by creating vibrancy and poignancy moment to moment you're saying it's self-protective if i think i'm protecting myself well why would i stop how do you get me to say exactly exactly okay if i think this is keeping me safe or you were talking about examples before that are literally life and death and i think i'm literally preserving my i'm trying to stay alive over here so why would i stop doing that how can i stop doing that that's the art of it you have to be very very respectful of that part and say that was important in this constraint in these rules when survival is of utmost importance and the other person was dangerous but stop for a minute and look in front of you who are you in front of right now is this person going to hurt you is this person trying to meet your needs it's different rules be fully present now how much of it then uh how much of the effects of trauma are in experiencing present day interactions um as not what they are basically tell you speak about trauma the opposite you speak about the opposite of trauma as being present tell me in very you know day-to-day grounded everyday terms what does that look like you know for instance in a relationship where i'm not reacting to you i'm looking at you but i'm reacting to something 10 years old or 50 years old or or even something happened not in my lifetime but affected yeah describe that experience for me you'll i'll be working with a family constellation of some sort parent-child couples or whatever they're talking about something very mundane in ordinary and all of a sudden it gets more heated emotionally there's either intensity of emotion or a dissociation from it it becomes intellectualized they start debating points like they start lawyering i call it where they're just debating like the truth of certain words and or i myself i myself will either get irritated or bored by the conversation and then i know that something's happening when you get bored that's a sign that something's happening yes because my my intention what i love is whenever i'm like pulsing with the other person whenever i'm feeling their story like a great movie you know like a great drama whether it's joyful or sad when you're in it it's like a rollercoaster of emotion then then that's that's real presence it's these waves of like experience over and over again but then whenever it's not happening i get very bored very quickly and then and then we can figure out why who just entered the room like whose parents just entered the room what hurt just entered the room that's taken over but so you're sitting in a room with with with with a family and all of a sudden things get out of nowhere out of the blue so to speak either really heated or really cold and in which case you're going to get bored and you're going to be like hey what's up why am i feeling bored like something something something hap something's happening here that's not real it's not authentic and and and what you're saying is you you you attribute that to someone entered the room like you don't mean physically and i just want to make sure everyone understands what you mean yeah describe that for me what what describe that in the more classical terms uh someone's gone into a reenactment uh in the trauma terms i've heard someone say that um they're having an emotional flashback in couples terms someone's called them demon dialogues so there's all these different words to use to describe these reenactments re-experiencing situations where for some reason a person's anger triggers in the other person uh memories visceral memories of a parent yelling and screaming at them and it's not conscious it's visceral visceral sometimes it can be conscious but as stress escalates self-awareness drops in direct proportion so it's not like someone says you're you're you're treating me just like my mother treated me they're not saying that they're just saying f off and then and then you're like why are you saying that all of a sudden because they don't they don't respect me and like in what point did respect come into this conversation why is it about that all of a sudden why are you experiencing it in in that filter you're saying it's oftentimes very incongruous like like out of the blue like how did that come up yeah when there's such a mismatch between the intention of the speaker and the way that this speech was received but you know what i'm thinking that's happening in the room in a therapeutic setting what you're describing what if that's happening a husband and wife are sitting at the dinner table and you're not there to referee and one person is reacting to another person who's not even in that room and is totally unaware that the the communication they're having is not even to each other all the time i'd say like 70 of our interactions are not with the person directly in front of us so so what do we do what do we do i mean i i i would assume then i'm making an assumption here but the goal is i mean correct me if i'm if i'm wrong but i guess a goal would be to learn how to respond to the person that's in front of me that's one goal that's the ideal goal for sure and the way to get there is that um you can't banish all these demons or ghosts in your past you just have to line them up next to you because they're acutely attuned to pick up on the thing that they're they were crafted to pick up on right but they shouldn't be the ones in control of the conversation they can advise you but they can't be in control so they're acutely attuned like they're experts at detecting certain yeah so if i was exposed to a certain kind of trauma i'm probably really good at sniffing that out yes and identifying it way before it's in my face yes right so if you're doing anything that's even remotely similar to something that my my little internal trauma expert is an expert in i'm going to think you're about to do it even if you're a thousand miles removed from actually posing that threat yeah before we're even aware of it that little person will know about it and so you want me to become aware of it and say okay that's an advisor you know like sitting on the shoulder and saying hey heads up this might resemble us an experience which has been traumatic in the past and then i should be able to tell my advisor it's cool it's just jacob hamm he's not going to kill me yeah well actually you should think like huh let me think about it for a second okay i thought about it it's just jacob no no big deal he's not gonna kill me yeah but thank you for thank you for keeping your guard up you thank the voice for keeping your wow yeah you have to but but but that internal voice let's say i come to you for to because trauma look nobody came to you because life is going well if they come to you it's because they're having problems if and then i find out my problem is trauma why wouldn't i be so angry at that voice that's ruining my life that's the enemy and you you want me to think that voice yeah god i only have a picture in my mind when i'm doing this work of coming to understand these parts of ourselves that are so hostile to us right be i keep having this image of like um someone just opened the door a crack and like get away from here we don't want anything you have to offer us and they want to slam the door on your face and then if you look past them then you often see this small child huddled in a fetal position on a couch and that part is trying to protect them wow wow so that's that's a very complex uh metaphor and visualization but basically you're saying i'm experiencing this voice that's that's very harsh very brash because its job is survival so i would i understand if its job is survival its going to be very harsh and brash but its not a bad guy he's trying to save me from getting hurt again but he's yeah but he but he's not doing a good job because he's making me get hurt again because if i'm in a conversation with you but i feel like on a visceral level i'm in a conversation that's you know 50 years ago so he's not letting me live he thinks he's helping me live he's not he's he's not letting me live you have to do two things one is that um you have to you have to start comforting that injured child behind that voice if you don't protect that child then that that need to protect will never go away and then once you start to comfort and heal that injured child then you can say look listen you were good back then but i had learned a few things since you're born and i know who this guy is in front of me i can handle this you're not in control anymore but you have to you have to start comforting and healing and hugging that little child first otherwise the need to protect that child never goes away okay talk about i i know we don't have a a great deal of time here and we'll have to you know have a follow-up i would love to have a continuation of our discussion but talk a little bit about what that looks like in an actual therapeutic setting when a person becomes aware let's say they're at the point where they've become aware of what that survival mechanism is how it served them and how it's not serving them what do i do now i talk to it i tell me what do i do okay i know it's there i know it's there and i know what it is what do i do this is where it becomes incredibly delicate and this is where i often want to tell people to shut up and stop thinking so much the way it looks is that um one they're incredibly activated and so it's hard to even engage them so i have to like get them back into the moment because they're reliving their traumas and then we just say like instead of having a clear plan let's just like turn our gaze to that part let's attend to it with tenderness and wait for it to tell us what it needs and or like wait to see what it says or what it gives you in terms of a memory and so you're changing this the what do i do about this is this um active problem-solving energy that's wrong for healing it's actually more about like a sitting back and receiving energy and it's different for each person how to get them into that and then when people get into that it's terrifying they feel vulnerable out of control because their self protective guard dogs aren't around them the people who are amazing at it they stop for a few minutes and they close their eyes and they look inward and then like a memory will show up of a little boy who was neglected or something like that or left behind a closet or in the in the bathtub hiding from the father who was raging and drunk and then when they reach that part then like a flood of emotions comes out they start reliving the terror of that moment but they also start experiencing grief and loss that their childhood was filled with that and that their life has been devastated by it and that's when the healing starts what do these voices um say that they need when when when we're quiet and we don't try to serve them we just try i don't know they never know you have to be the grown-up in this moment it's when it's like the toddler that's just like crying on the floor you have to swoop it up so there's a voice inside of me with this great urgency that you know this is life or death this is life or death this is life or death and finally when we're just quiet we say okay sweetie what do you need and he doesn't even know you start with the hug it's like with my three-year-old like whenever he's crying um the the classic response from survival parenting is like no no no inside voice gentle tone like say it properly like his lego just broke right and he's like screaming bloody murder that the lego pieces fell apart and most people's response is to regulate the expression of that emotion but from my training as a psychologist i know like a three-year-old is all limbic energy no capacity for self-regulation or like limited capacity for self-regulation and that what he needs is for me to be the regulator and so i i come in and i say oh no what happened oh no and i try to give him soothing energy in my voice my intonation my cadence maybe touch if he allows it yet to be careful about that and then he tries to put it into words it broke i say oh no it broke and so me knowing him in his pain starts to bring him back down okay you're describing the you know good parenting of a toddler but you're using that as a metaphor because now let's let's talk about healing from trauma there's no actual toddler i'm the toddler i'm the adult and i'm the toddler so what does that mean do you ever talk to yourself like that when you make a mistake when you're in your depression so-called depression when you're like saying this will never get better or whenever you're hurt typically where we say like suck it up stop whining about it or whatever we treat ourselves horribly it should be more like why did that hurt so much what's going on you make space for that pain is is that is that a skill that can be taught yes it can't doesn't it's not taught intellectually though or mechanistically you have to live it you have to do not a checklist it's not like a behavioral checklist do this do this do this it's hard it's hard for people to do that because whenever you're activated then the child takes over or the inner critic takes over the part of you that could follow a checklist disappears even if you had the checklist it wouldn't help okay so then what sometimes sometimes it can but it's really hard like um i i talk about whenever um i'm working with schools and i want them to create like a uh you know how they used to have time out spaces in in school to punish kids who are acting out and to deprive them of any positive reinforcements nowadays in a more trauma-informed approach they use a calm space a chill out space where they put like soothing pillows or like manipulatives or any kind of sensory toys in there that are that provide comfort and regulatory input and then what i would suggest that people add is a letter that the child writes to themselves whenever they're upset or a letter from their mom or something like that whenever they're upset hey johnny you're i know you're having a tough time but i love you nonetheless and i know how much you love school and once we figure out why you're upset you can get back to playing and enjoying school again something comforting to ingrain that self into the head too i i know that your your expertise is in trauma and um you know as as we've mentioned trauma is caused by something it has a cause but i'm just curious to what extent do you feel like what you're describing you know like harsh inner critic that kind of you know the negative voice um that fight or flight that's just unnecessary that sounds like a lot of us that sounds like maybe all of us to what extent do you think this stuff is kind of universal and not just specific to those who have had trauma in the most conventional sense there's something about that question that i find so bad and but not i'm not criticizing you but i'm criticizing the world because we want to other people with disease or suffering we want to say like that's not me i'm not traumatized whereas i would say that we can all be traumatized this what i'm describing is all too human but it's the severity of it the stuckness of it that really um distinguishes someone who can live their life with despite their inner critics or someone who is incapacitated by it okay so let me let me you know language is important let me rephrase that instead of talking about trauma victims and non-trauma victims let's just assume that trauma is universal and that what varies from person to person is the degree so those of us who believe at least that we've had a minor degree of trauma and maybe we really have had a very minor degree what do we need to know for ourselves what is the knowledge of of of trauma help a person who says and even rightfully says i never had a severe degree of trauma i'll give you the quick answer the questions that i would ask the questions that i would want that person to ask themselves is do you live by your aspirations and your goals do you live led by your by the desire for love and by your virtues or are you living in like a risk avoidant fear-based way of thinking and the longer answer is that um see if we focus on trauma then it's the wrong thing what we should be focusing on is um the way that the brain works and that there's this limbic part of us that's driven by fear and survival and basic stuff like food and the four fs that we learned in school and sleep and all this biological stuff and then there's this higher self that's located in the prefrontal cortex and those two are always battling with each other because the survival part of the brain always has precedence it has carte blanche authority to take over and then the prefrontal part is incredibly difficult to maintain it takes a lot of maturation it's the last part of the brain to develop in there in the early 20s for women and in the mid-20s for men it's the first thing that gets injured it's the first thing that gets depleted in the with the lack of sleep or food it um some people have argued that it's actually like a peacock's tail that it's a display of um good parenting and good resources whenever you have a great prefrontal cortex so those two parts of us are always warring and what trauma does is that it's like an incredibly profound driver of who wins that battle and they've done imaging studies to show that trauma has these enormous impacts on enlarging the amygdala on like increasing blood flow to that part of the brain to decreasing blood flow and making parts of the prefrontal cortex atrophy it's a trump card in terms of who wins that battle but that's a battle that we all struggle with wow so basically this is the human condition yes and the degree of trauma basically is the degree to which that universal struggle has been amplified any final message for now as far as what you would want someone who's listening to this uh obviously they're watching this something piqued their curiosity maybe it's because they heard of trauma maybe they think maybe they have trauma what do you want somebody to do now after they're finished watching this wow that is an exciting moment when they're on the precipice of change keep looking keep searching there's no one answer don't land on one answer keep growing keep trying new things i constantly am learning new things and trying new things and then share what you've learned with other people i want to thank you for sharing what you've learned with us and uh there's a lot of food for thought here and a lot of interesting ways of of looking at this subject that you've given us uh i have to uh i feel like i want to take a walk now and just sort of unpack everything you've told me mission accomplished then yeah i love it i love it i really i thank you i thank you for talking about this this subject and i'm sure i'm sure that it will um at least one person will will find that it's directly helpful in their next next phase next step in life that is all i ask for let this be of use for one person and then it'll be worth our time beautiful thank you we got to do it again definitely okay all right be well you too [Music] bye-bye [Music] you